Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery: A prospective observational study

doi:10.12998/wjcc.v11.i16.3791

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Clin Cases. Jun 6, 2023; 11(16): 3791-3801
Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3791

Table 1 Baseline demographic and clinical characteristics in all patients and according to acute kidney injury status

Total population (%)	N = 206	AKI	No AKI	P value
Total population (%)	206 (100)	55 (26.7)	151 (73.3)	P value
Baseline pre-operative characteristics
Gender, female	62 (30.1)	13 (23.6)	49 (32.5)	0.236
Age (yr)	70 (59-76)	74 (59–79)	68.5 (59–74)	0.039
BMI (kg/m²)	27.8 (25.2-31.3)	27.0 (24.8–30.0)	28.1 (25.4–31.5)	0.308
EuroScore II (%)	1.7 (1.09-2.9)	2.54 (1.52–4.4)	1.54 (0.94–2.4)	0.0001
Hb (gr/dL)	10.3 (9.6-11)	10.3 (9.8–10.9)	10.2 (9.5–11.0)	0.603
WBC (×10³/μL)	10.3 (7.9-13.1)	11.4 (8.9–13.7)	9.5 (7.5–12.8)	0.015
Creatinine (mg/dL)	0.9 (0.8-1.1)	1.0 (0.9–1.3)	0.9 (0.8–1.1)	0.009
CKD	50 (24.3)	22 (40)	28 (18.5)	0.003
eGFR (mL/min/1.73 m²)	79.1 (60.2-89.9)	69.1 (52.3-84.2)	81.3 (63.1-90.8)	0.007
PPC	5 (2.4)	1 (1.8)	4 (2.6)	1.0
ICD	5 (2.4)	4 (7.3)	1 (0.7)	0.019
PAD	10 (4.9)	4 (7.3)	6 (4)	0.462
Thyroid disease	36 (17.5)	7 (12.7)	29 (19.2)	0.309
Stroke	3 (1.5)	1 (1.8)	2 (1.3)	1.0
Intraoperative characteristics
CPB (Extracorporeal circulation)	198 (96.1)	51 (92.7)	147 (97.4)	0.214
Duration of CPB (min), Ν = 198	112 (84-145)	121 (104–171)	106 (80–141)	0.009
Aortic cross-clamp time (min), Ν = 193	89 (59-108)	87 (67–111)	77 (56–107)	0.067
Duration of general anesthesia in surgery (min)	240 (190-300)	273 (213–350)	229 (183–300)	0.016
CABG	116 (56.3)	29 (52.7)	87 (57.6)	0.634
Heart valve repair	7 (3.4)	1 (1.8)	6 (4)	0.678
Aortic valve replacement	71 (34.5)	20 (36.4)	51 (33.8)	0.743
Mitral valve replacement	15 (7.3)	4 (7.3)	11 (7.3)	1.0
Tricuspid valve replacement	7 (3.4)	2 (3.6)	5 (3.3)	1.0
Mixed valve replacement	10 (4.9)	2 (3.6)	8 (5.3)	1.0
Aneurysm repair	23 (11.2)	5 (9.1)	18 (11.9)	0.803
Acute aortic dissection	4 (1.9)	3 (5.5)	1 (0.7)	0.059
Heart transplant	4 (1.9)	3 (5.5)	1 (0.7)	0.059
Post-operative characteristics
Duration of mechanical ventilation (min)	780 (591-1198)	1113 (777–2195)	714 (511–1020)	0.0001
Duration of sedation in ICU (min)	360 (250-600)	540 (300–810)	300 (240–480)	0.0001
Duration of sedation during and post surgery (min)	593 (480-842)	754 (540–1245)	570 (476–740)	0.0001
Fluid balance 24 h post surgery (mL)	722 (70-1418)	1090 (330–1862)	501 (11–1150)	0.001
Fluid balance 48 h post surgery (mL), (N = 146)	N (%); 146 (70.9)	46 (31.5)	100 (68.5)	0.526
Fluid balance 48 h post surgery (mL), (N = 146)	-202 [(-1146) - 377]	-163 [(-1186) – 531]	-248 [(-1099) – 296]	0.526
Systolic blood pressure (mmHg)	119 (105-135)	116 (103 – 134)	120 (108–135)	0.162
Diastolic blood pressure (mmHg)	61 (55-70)	58 (54–65)	63 (55–70)	0.015
Mean arterial blood pressure (mmHg)	80 (71-88)	75 (68–84)	80 (74–89)	0.005
Vasopressors	65 (31.6)	27 (49.1)	38 (25.2)	0.002
Inotropes	130 (63.1)	41 (74.5)	89 (58.9)	0.05

AKI: Acute kidney injury; BMI: Body mass index, Hb: Hemoglobin, WBC: White blood cells; sCr: Serum creatinine, HTN: Hypertension; CKD: Chronic kidney disease defined as eGFR ≤ 60 mL/min/173 m²; PPC: Permanent pacemaker; ICD: Implantable cardioverter defibrillator; PAD: Peripheral artery disease; CPB: Cardiopulmonary bypass, ICU: Intensive care unit. All continuous variables are presented as median (interquartile range) and categorical variables as absolute values (%). Statistical significance was set at P value less than 0.05.

Table 2 Univariate logistic regression analysis for acute kidney injury development

Variable	Exp (B)	95%CI	P value
Preoperative characteristics
Female sex	0.64	0.32–1.31	0.224
Age	1.02	0.99–1.05	0.125
BMI	0.98	0.92–1.05	0.601
EuroScore II	1.21	1.08–1.34	0.001
Hb	1.01	0.76–1.34	0.948
WBC	1.0	1.0–1.0	0.014
Creatinine	1.5	0.76–2.96	0.246
HTN	0.86	0.4–1.85	0.699
Diabetes	0.91	0.47–1.75	0.777
CKD	2.93	1.49–5.77	0.002
CAD	1.02	0.53–1.96	0.959
CHF	0.12	0.01–1.14	0.64
PCP	1.47	0.16–13.44	0.733
PAD	0.53	0.14–1.95	0.337
Thyroid disease	1.63	0.67–3.97	0.282
Stroke	0.73	0.06–8.16	0.794
Intraoperative characteristics
Duration of CPB	1.01	1.0–1.01	0.044
Aortic cross-clamp time	1.01	1.0–1.01	0.222
Duration of general anesthesia in surgery	1.0	1.0–1.01	0.031
Postoperative characteristics
Systolic blood pressure	0.99	0.97–1.01	0.181
Diastolic blood pressure	0.97	0.94–1.0	0.026
Mean arterial blood pressure	0.97	0.94–0.99	0.009
Duration of mechanical ventilation	1.043	1.02-1.066	< 0.001
Duration of sedation in ICU	1.0	1.0–1.0	0.004
Duration of sedation during and post surgery	1.0	1.0–1.0	0.003
Fluid balance 24 h post surgery	1.0	1.0–1.0	0.007
WBC	1.11	1.02–1.21	0.014
Vasopressors	0.35	0.18–0.67	0.001
Inotropes	0.49	0.25–0.98	0.042

AKI: Acute kidney injury; BMI: Body mass index; Hb: Hemoglobin; WBC: White blood cells; sCr: Serum creatinine; HTN: Hypertension; CAD: Coronary artery disease; CKD: Chronic kidney disease; CHF: Chronic heart failure; PPC: Permanent pacemaker; ICD: Implantable cardioverter defibrillator; PAD: Peripheral artery disease; CPB: Cardiopulmonary bypass; ICU: Intensive care unit. Statistical significance was set at P value less than 0.05.

Table 3 Receiver operating characteristics curve analysis for major predictors of acute kidney injury development

Test result variable(s)	Area under curve	SE	P value	95%CI
Test result variable(s)	Area under curve	SE	P value	Lower bound	Upper bound
CKD	0.602	0.050	0.036	0.504	0.699
EuroScore II percentage (%)	0.692	0.045	0.000	0.604	0.781
Duration of ECC (min)	0.618	0.044	0.015	0.532	0.704
Duration of GA (min)	0.607	0.047	0.028	0.515	0.699
Duration of ICU sedation (min)	0.625	0.051	0.010	0.526	0.724
White blood cell (k/uL)	0.643	0.046	0.003	0.554	0.733
Vasopressors	0.610	0.049	0.024	0.514	0.706
Inotropes	0.562	0.047	0.204	0.469	0.654
Fluid balance 1^st day after cardiac surgery (mL)	0.634	0.050	0.006	0.537	0.731

ECC: Extracorporeal circulation; GA: General anesthesia. The statistical significance was set at P value less than 0.05.

Table 4 Outcome characteristics of all patients and according acute kidney injury status

Outcome	AKI	No AKI	P value
Reintubation (n)	6 (10.9)	2 (1.3)	0.005
Dialysis (n)	4 (7)	0	0.005
Duration of mechanical ventilation (min)	1113 (777–2195)	714 (511–1020)	0.0001
Delirium (n)	20 (36.4)	36 (23.8)	0.001
ICU acquired weakness (n)	9 (16.4)	8 (5.3)	0.015
ICU length of stay (hours)	70 (28–129)	26 (21–51)	0.0001
Mortality (n)	2 (3.6)	1 (0.7)	0.046

AKI: Acute kidney injury; ICU: Intensive care unit.

Citation: Dimopoulos S, Zagkotsis G, Kinti C, Rouvali N, Georgopoulou M, Mavraki M, Tasouli A, Lyberopoulou E, Roussakis A, Vasileiadis I, Nanas S, Karabinis A. Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery: A prospective observational study. World J Clin Cases 2023; 11(16): 3791-3801
URL: https://www.wjgnet.com/2307-8960/full/v11/i16/3791.htm
DOI: https://dx.doi.org/10.12998/wjcc.v11.i16.3791